Know the Facts: Condoms and Contraception

Opponents of comprehensive sexuality education spend a great deal of time talking about condoms and other contraceptives. They often refer to comprehensive sexuality education programs as “condom education.” This is an unfair characterization of comprehensive sexuality education programs which include information on numerous topics from relationships and love to sexuality and the media.

This focus on condoms/contraception seems to be based on two flawed beliefs. First, it stems from the belief that educating teens about contraception is tantamount to providing them with permission to have sex and will ultimately increase sexual activity. Second, it stems from the belief that teaching teens that contraception does not work will convince them not to have sex. Neither of these assertions are supported by research.

This fact sheet is designed to make you aware of some of the myths you may hear about contraception and help you formulate your response. The best responses are often in the form of a sound byte—short, catchy phrases that are easy for others to understand and remember. This fact sheet provides you with a number of sound bytes as well as the facts and research you need to debunk the myths and get your message out.

CONDOMS AND CONTRACEPTION: MYTH 1

Opponents often misrepresent or exaggerate condom failure rates in an effort to convince teens that condoms won’t work.

Research tells us that when used consistently and correctly condoms are 98 percent effective in preventing pregnancy. The most important thing to understand is the difference between method failure and user failure. Method failure refers to failure resulting from a defect in the product (such as a tear in a condom). This is very rare. Experts estimate that condoms break or slip only two percent of the time.

What Opponents May Say: “Condoms don’t protect against pregnancy.”

What You Can Say: If used consistently and correctly condoms can be 98% effective in preventing pregnancy.

User failure refers to failure resulting from incorrect or inconsistent use. User failure is calculated by looking at 100 couples who use condoms as their primary method of birth control. Over the course of the first year, about 14 of these couples will experience an unintended pregnancy. It is important to remember that these couples may not have been using a condom or may have been using a condom incorrectly during the act of intercourse that resulted in an unintended pregnancy.

To further put this in perspective, it helps to look at other contraceptive methods. For example, 26 percent of women using periodic abstinence as a method of birth control will experience an unintended pregnancy within the first year as will 85 percent of those using no method.

Opponents of comprehensive sexuality education often purposefully blur this distinction in order to convince parents and students that condoms never work. In truth, condom failure is most often caused by errors in use and the failure of couples to use a condom every time they have sexual intercourse. This type of failure can be solved if teens are taught to use condoms consistently and correctly.

For years, opponents of comprehensive sexuality education have used the analogy of Russian Roulette to suggest that condoms fail far more often than is true. One curriculum describes the analogy this way:

What Opponents May Say: “Using a condom is like playing Russian Roulette.”

“The first player spins the cylinder, points the gun to his/her head, and pulls the trigger. He/she has only one in six chances of being killed. But if one continues to perform this act, the chamber with the bullet will ultimately fall into position under the hammer, and the game ends as one of the players dies. Relying on condoms is like playing Russian Roulette.”*

This inaccurately suggests that condom failure is cumulative—that the odds of getting pregnant the second time one has sex with a condom is somehow higher than the first.

What You Can Say: Not using condoms is a far riskier game for sexually active teens.

Method failure of the male condom is very low (about two percent), and it remains that low no matter how often one has sexual intercourse using a condom. Most condom failure is user failure, which can be overcome if condoms are used consistently and correctly. In fact, the more often couples use condoms, the more likely they are to use them correctly thereby lowering the chances of user failure.

In recent years, opponents of comprehensive sexuality education have gone to great lengths to shake people’s confidence in condoms as a method of disease prevention. The truth is, however, condoms can help protect sexually active individuals from a number of STDs.

According to the Centers for Disease Control and Prevention (CDC), latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS. In fact, researchers have concluded that using a condom during intercourse to protect against HIV transmission is 10,000 times safer than not using a condom.

What You Can Say: Research shows that condoms are very effective in preventing the transmission of HIV and can reduce the risk of other STDs.

The CDC goes on to say that when used consistently and correctly condoms can reduce the transmission of gonorrhea, Chlamydia, and trichomoniasis. Condoms can also reduce the risk of transmission for other STDs such as genital herpes, syphilis, chancroid, and HPV, however, only when the infected areas are covered or protected by the condom.

One common myth about condoms suggests that latex has large pores that will allow HIV to pass through. Opponents of comprehensive sexuality education sometimes illustrate this by suggesting that the size difference between a sperm cell and HIV is like the difference between the football field and the football. They go on to assert that while condoms might successfully stop sperm, small holes allow HIV to pass through.

The U.S. Food and Drug Administration (FDA) regulates manufacturers who sell condoms in the United States. As a quality assurance step, condom manufacturers sample each lot of finished packaged condoms and examine them for holes using a water leak test. The FDA recognizes domestic and international standards that specify that the rate of sampled condoms failing the water leak test must be less than one in 400 for each manufactured lot of condoms. Manufacturers also test lots for physical properties using the air burst test and the tensile (strength) property test.

What Opponents May Say: “Condoms have holes that allow HIV to pass through.”

What You Can Say: Condoms are subject to strict regulation, any imperfections such as holes are extremely rare.

In order to test condoms’ ability to prevent the passage of viruses, FDA researchers developed a test using high concentrations of a laboratory created “virus” that was the same size as STD pathogens. They tested many different types of male condoms and determined that condoms are highly effective barriers to virus passage with a very small chance of leakage. Intact condoms (those that pass the water leak test) are essentially impermeable to particles the size of STD pathogens. Moreover, these studies show that fluid flow, not virus size, is the most important determinant of whether a virus will pass through a hole.

Just as with sexuality education, many people fear that giving young people access to condoms will lead to an increase in sexual activity. The good news is that these fears are unfounded.

Research has shown that condom availability programs do not lead to an increase in sexual activity. A study comparing New York City public high schools that had a condom availability program to similar public high schools in Chicago that did not have such a program found that condom availability does not increase rates of sexual activity but does have a positive impact on condom use.

What Opponents May Say: “Making condoms and other contraceptive methods available in school is like handing out a license for sex. It will just lead to teens having more sex.”

What You Can Say: Making condoms available to teens does not increase sexual activity but does increase condom use.

A more recent study found that sexually active participants in schools with condom availability programs were more likely to use contraception at last intercourse than sexually active participants in schools without condom availability programs.

Sources: Sally Guttmacher, et al., “Condom Availability in New York City Public High Schools: Relationships to Condom Use and Sexual Behavior,” American Journal of Public Health 87 (September 1997): 1427-1433; and Susan Blake, PhD et al., “Condom Availability Programs in Massachusetts High Schools: Relationships with Condom Use and Sexual Behavior,” American Journal of Public Health 93.6 (June 2003): 955-961.

UNSOUND REASONING: “CAN’T TEACH ABOUT CONDOMS”

The Medical Institute for Sexual Health, a strong opponent of comprehensive sexuality education, acknowledges that “in a specific sexual encounter the likelihood of experiencing negative physical consequences (pregnancy or disease) may be reduced when a condom is used.” It goes on to argue, however, that since “the protective value of condoms is dramatically reduced if they are not used correctly for every sexual encounter,” it is wrong for schools to “promote condom use outside of marriage.”

It is true that teens (like adults) do not always use condoms consistently and correctly. This does not, however, mean that they are incapable of doing so if they have the necessary knowledge and skills. According to the CDC, “studies of hundreds of couples show that consistent condom use is possible when people have the skills and motivation to do so.” Similar arguments are made about other forms of contraception, such as oral birth control pills, when people suggest that teens can’t be trusted to use these methods correctly.

What You May Hear: “Teens are terrible at using contraception. So, teaching teens that condoms and pills don’t work is the only moral thing to do.”

What You Can Say: Teaching teens that contraception doesn’t work will not stop them from having sex. It may, however, stop them from protecting themselves when they do become sexually active— ultimately making them more vulnerable to pregnancy and disease.

These arguments hinge on the notion that if teens believe condoms and other contraceptives will not protect them against STDs or pregnancy, they will ultimately decide not to have sex. There is no evidence that this assumption is true. Informing teens that contraception doesn’t work does not mean that they won’t have sexual intercourse. It may mean, however, that they won’t use protection when they do. For example, the CDC warns that “people who are skeptical about condoms aren’t as likely to use them — but that doesn’t mean they won’t have sex.”

This tactic of providing inaccurate and incomplete information in the hopes of changing behavior is likely to backfire and it will be our young people who suffer.

In recent years there has been a lot of discussion and debate about the Human Papillomavirus (HPV), the virus that causes genital warts. Much of the debate has centered on the relationship between HPV and cervical cancer in women and whether condoms provide any protection against the spread of HPV and cervical cancer. Opponents of comprehensive sexuality education, often try to raise people’s fear by suggesting that HPV inevitably leads to cervical cancer and that condoms provide no protection from this disease. These claims are false.

According to a report by the CDC, the majority of HPV infections resolve themselves spontaneously and do not lead to any longterm consequences. The report explains that: “While infection with high-risk types [of HPV] appears to be ‘necessary’ for the development of cervical cancer, it is not ‘sufficient’ because cancer does not develop in the vast majority of women with HPV infection.”

What Opponents May Say: Condoms provide no protection against HPV leaving our young people exposed to cervical cancer.”

What You Can Say: They are not perfect, but condoms significantly reduce the risk of getting HPV and related health problems like genital warts and cervical cancer.

The report also emphasizes the importance of routine screenings for pre-cancerous cells using the Pap test. The CDC estimates that approximately half the cases of cervical cancer that occur each year will occur in women who have never had a Pap test and an additional 10% will occur in women who were not screened in the last five years.

In addition, the CDC explains that condoms can be used in the fight against HPV and cervical cancer. It is true that condoms cannot provide complete protection from HPV, in part because infections may occur on sites not covered by the condom. However, the report says “laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of HPV” and that “studies of HPV infection in men demonstrate that most HPV infections are located on parts of the penis that would be covered by a condom.” In addition, new research in June 2006 showed that young women who used condoms were 70% less likely to contract HPV and previous research has shown that the use of latex condoms is associated with a reduction of HPV-associated diseases such as cervical cancer.

There is a great deal of confusion about emergency contraception which became widely available after it received Food and Drug Administration (FDA) approval in the late 1990’s. Emergency Contraception (EC), also referred to as “the morning after pill,” is a high dose of regular birth control pills that can reduce a woman’s chance of becoming pregnant by 75 to 89 percent if taken within 72 hours of unprotected intercourse.

Many people confuse EC with the RU- 486 or mifepristone, often called the “abortion pill.” EC is not the same thing and cannot end a pregnancy. The FDA explains that EC works by delaying or inhibiting ovulation or inhibiting implantation. If an egg has already implanted in a woman’s uterus, EC will not terminate the pregnancy nor will it harm the developing fetus.

What Opponents May Say: Emergency contraception is just another method of abortion.

What You Can Say: Emergency contraception does not cause abortion.

In fact, research suggests that the availability of EC has led to a decrease in abortions. According to the Alan Guttmacher Institute, emergency contraceptives accounted for up to 43% of the decrease in total abortions between 1994 and 2000, and an estimated 51,000 abortions were averted by women’s use of emergency contraceptives in 2000 alone.

Although EC is an important method for teens who may have had unprotected sexual intercourse, many adults fear that informing teens about this option and allowing them to access EC will lead to a widespread increase in teen sexual behavior.

Research suggests, however, that this is not the case. A 2002 study in England compared teens who had received instruction about emergency contraception with peers who had not. The study found that the intervention significantly improved the proportion of students who knew correct information about emergency contraception but did not change the students’ sexual activity or actual use of EC. New research among adult women in the U.S. also suggests that access to emergency contraception does not lead to an increase in unprotected sexual intercourse.